How Were You Introduced to RA_______________________________________
Name__________________________
Name of Spouse__________________
Home Address_____________________________________________________
Country __________________________________________________________
Home Telephone:________________
Email address:_____________________
Office Address ____________________________________________________
Office Telephone: ______________________ Office Fax: ___________________
Please Send Info to (Tick one) ______ Home ________ Office
City and State of Last Registered Voting District __________________________
Spouse – City and State__________________________________________
I am a US Citizen _______ Yes ____________No
Membership Categories
Presidential $ 5000 ________ Envoy $250___________
Ambassador $1000 _________ Sponsor $100____________
Diplomat $500 __________ International $50__________
I Am Willing to Help Republicans Abroad With:
Membership_____ Fundraising Special Events______
Mailings_____ Newsletters/Websites___ Voter Registration _____
State Liaison ___ Public Events ________ College Liaison _______
Credit Card Number____________________________ Card type amex/visa/mastercard
Expiry Date_____________
Please print and send this form, along with your Cheque in US Dollars Made Payable to:
Republicans Abroad International, 1275 K Street, NW, Suite 102, Washington, DC 20005
Signature____________________________
Financial contributions to Republicans Abroad are critically important in mobilizing Americans overseas to vote, keeping Americans abroad abreast of fast-breaking political developments in the United States, and in representing the interests of Americans overseas to decision-makers. DONATE NOW
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Not Authorized by any Candidate or Candidate's Committee.
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